NPIMap

Organization Active NPI

Memorial Hospital, Inc

  • Clinical Medical Laboratory
  • Neillsville, WI
National Provider Identifier
1679746747
Registry record updated Apr 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
MEMORIAL HOSPITAL, INC
Practice address
216 Sunset PL
Memorial Hospital, Inc
Neillsville, WI 54456-1706
Phone
(715) 743-3101
Fax
(715) 743-6245
NPI assigned
Apr 9, 2008
Last updated
Apr 16, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Scott Polenz, CEO
Title
Administrator
Phone
(715) 743-3101

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X WI Primary

Addresses

Primary practice location

216 Sunset PL
Memorial Hospital, Inc
Neillsville, WI 54456-1706

Mailing address

216 Sunset PL
Memorial Hospital, Inc
Neillsville, WI 54456-1706
Phone (715) 743-3101

Other identifiers 1

IdentifierTypeStateIssuer
32947200MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110526000807 WI Part A Provider - Critical Access Hospital 2365433224 Receives reassigned benefits from 1,228 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Loyal, WI; Neillsville, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1679746747. Details of each certification follow.

Hospital certification: CCN 521323

Legal name
MEMORIAL HOSPITAL INC
Doing business as
MARSHFIELD MEDICAL CENTER - NEILLSVILLE
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Aug 1, 2002
Last certification
Aug 7, 2025
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Enrollment address
N3708 River Ave
Neillsville, WI 54456-7218
Main/Primary Hospital Location

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Marshfield Medical Center - NeillsvilleCCN 521323 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 15

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Brian D Hoerneman Individual Corporate OfficerPresident, Ceo Apr 4, 2023
Corporate DirectorBoard Member Apr 5, 2023
Tony Lee Morrison Individual W-2 Managing Employee Jan 1, 2025
John F Baltus Individual Corporate OfficerTreasurer, Secretary, Vice Chair Sep 8, 2023
Corporate DirectorBoard Member Feb 3, 2016
Sanford Organization, Fargo, ND Corporation, Non-profit, Chain home office 5% Or Greater Indirect Ownership Interest Jan 1, 2025 100%
Jolyn Joy Munson Individual W-2 Managing Employee Jan 1, 2025
Dennis H Smith Individual Corporate DirectorBoard Member Jan 14, 2025
Jeffrey Douglas Poppen Individual Corporate OfficerCfo - Marshfield Jun 12, 2025
W-2 Managing EmployeeCfo - Marshfield Jun 12, 2025
Edward G Fernandez Individual Corporate OfficerChair Jan 1, 2025
Corporate DirectorBoard Member Sep 9, 2023
MCHS Hospitals Inc Organization, Marshfield, WI Corporation, Non-profit 5% Or Greater Direct Ownership Interest Dec 1, 2018 100%
Samantha L Klebe Individual Corporate DirectorBoard Member Sep 9, 2023
W-2 Managing EmployeeChief Physician Jan 1, 2025
Linda Laverne Procci Individual Corporate DirectorBoard Member Feb 1, 2025
Everett W Newcomb Individual Corporate DirectorBoard Member Sep 13, 2024
Marshfield Clinic Health System Inc Organization, Marshfield, WI Non-profit 5% Or Greater Indirect Ownership Interest Dec 1, 2018 100%
Douglas Mathison Individual Corporate DirectorBoard Member Dec 16, 2020
Nicholas Wayne Olson Individual W-2 Managing EmployeeCfo, Executive Vice President Jan 1, 2025

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Affiliated clinicians 139

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 139

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1207699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208304000000",
    "number": "1679746747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "216 SUNSET PL",
            "address_2": "MEMORIAL HOSPITAL, INC",
            "city": "NEILLSVILLE",
            "state": "WI",
            "postal_code": "544561706",
            "telephone_number": "715-743-3101",
            "fax_number": "715-743-6245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "216 SUNSET PL",
            "address_2": "MEMORIAL HOSPITAL, INC",
            "city": "NEILLSVILLE",
            "state": "WI",
            "postal_code": "544561706",
            "telephone_number": "715-743-3101",
            "fax_number": "715-743-6245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL HOSPITAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-09",
        "last_updated": "2008-04-16",
        "status": "A",
        "authorized_official_last_name": "POLENZ",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "715-743-3101",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32947200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Neillsville, WI

Sources for this page

Verify at the official NPI Registry.